Ictal chest discomfort in a patient with temporal lobe seizures and amygdala enlargement

Epilepsy Behav Rep. 2022 Dec 17;21:100578. doi: 10.1016/j.ebr.2022.100578. eCollection 2023.


Chest discomfort is the representative symptom of dangerous coronary artery disease (CAD), but rarely occurs in patients with seizures. We treated a 74-year-old man with right mesial temporal lobe epilepsy and amygdala enlargement, who was initially suspected of CAD and underwent repeated cardiac angiography because of recurrent episodes of paroxysmal chest discomfort starting from 68 years old. He visited an epileptologist and underwent long-term video electroencephalography monitoring (LTVEM), which confirmed right temporal seizure onset during a habitual episodes of "chest discomfort," stereotyped movement of chest rubbing with the right hand, followed by impaired conscousness. Brain magnetic resonance imaging revealed right amygdala enlargement. The present case emphasizes the importance of the wide range of symptoms, such as chest discomfort, which may associated with epielpsy and result in a delayed diagnosis. LTVEM is useful for diagnosis of epilepsy with unusual seizure semiology by recording ictal EEG changes during chest discomfort.

Keywords: AMPAR, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor; Amygdala enlargement; CAD, coronary artery disease; CAG, coronary angiography; CASPAR2, contactin-associated-protein-receptor-2; Chest discomfort; EEG, electroencephalography; GABABR, γ-aminobutyric acid-B receptor; LGI-1, leucine-rich glioma-inactivated ptotein-1; LTVEM, long-term video electroencephalography monitoring; MRI, magnetic resonance imaging; Mesial temporal lobe epilepsy; NMDA, N-methyl-D-aspartate receptor; TLE, temporal lobe epilepsy; mTLE, mesial temporal lobe epilepsy.

Publication types

  • Case Reports